The following information will guide you through the application process
Complete your application and gather all required documents as described in each step below. This is not an all-inclusive list; for questions on other documentation that can be submitted contact the Texas Ten Step coordinator. Use the optional tools to assess your facility’s application and progress.
Submit all documents to TexasTenStep@hhs.texas.gov
Please send large files in separate emails and indicate the step in the subject line.
Documents may also be mailed to: (no hard binders, please)
Texas Ten Step Coordinator-Infant Feeding Branch
4616 West Howard Lane
Bldg. 8, Suite 840, MC 1933
Austin, TX 78728
Application and Support Documents
Submit your Texas Ten Step Application (required for designation)
Helpful tools to complete your application (not required for designation)
- Scorecard Evaluation (PDF)
Our TTS scorecard has been revised! Visit the Scorecard Evaluation Tool page to learn more about the updated criteria.
- Ten Step Self-Assessment tool (PDF)
- Document Checklist (PDF)
View details below for each step.
- Scorecard Evaluation (PDF)
Support documents include all policies related to infant feeding and the Ten Steps. Policies should include signature page and current review dates. Policies in draft form are not accepted. For policies stored electronically that do not include signatures, send a cover sheet with the manager or director’s signature verifying these are the current policies in use.
- Include policies or guidelines related to infant feeding.
- Include policies or guidelines that address individual Ten Steps if they are separate from the main infant feeding policy (ex: rooming-in, skin-to-skin, supplementation, pumping, etc.).
- Only include NICU policies that relate to Ten Steps (Kangaroo care, pumping/ hand expression/ storage).
- Include information on any quality improvement project(s) you are conducting related to breastfeeding or the Ten Steps.
Support documents for training can include:
- PowerPoint presentations
- Research articles with post-tests
- Training provided during staff meetings
- Poster board presentations
- Outsourced or purchased training
Documentation for skills-based testing can include check-off sheet or list of skills covered during review.
- The Texas Ten Step program reviews the following criteria for Step 2, staff training:
- Training must include didactic and skills-based components
- Training must demonstrate >50% staff completion.
- Do not include trainings for which <50% staff have attended.
- Do not include trainings specific for lactation staff only.
- Training must include dates from previous two years only.
WIC offers both online and live training that help meet the didactic content for Step 2 training. If your facility does not use the WIC trainings offered, complete the application demonstrating the content listed within is covered.
- Health risks to mom and baby of suboptimal exclusive breastfeeding (for example, not achieving medical recommendations).
- Anatomy and physiology, breastmilk components and milk production. The importance of early breastfeeding and intake of colostrum. Assessing good/ poor milk transfer.
- How to solve common breastfeeding problems (sore nipples, flat/inverted nipples, engorgement, blocked ducts, mastitis, sleepy and fussy infant, etc.)
- Impact of introducing formula, artificial nipples, and pacifiers before breastfeeding is established, the International Code of Marketing of Breastmilk Substitutes.
- Labor and birth practices that support early breastfeeding. Regardless of feeding method, the importance of feeding on-cue, skin-to-skin contact, rooming-in and safe sleep and SIDS risk reduction.
- Knowledge of discharge referral process and arranging follow-up suitable to the mother’s situation to include familiarity of available community resources.
- Orientation should include supervised clinical experience (shadowing) with IBCLC, CLC or other staff with additional breastfeeding education beyond basics.
All skills-based training must be completed in the presence of preceptor. Read/study modules should not be included as skills-based testing.
- Provide evidenced based key messages to pregnant and postpartum women regarding exclusive breastmilk feeding, using effective counseling and communication techniques.
- Observing, assessing, and assisting with breastfeeding position and latch.
- Teaching hand expression, pump use and set up and safe storage and milk.
- Teaching safe formula preparation and feeding (paced feeding, newborn stomach capacity).
Support documents can include PowerPoint presentations, education books and any handout provided to mothers during class as it relates to infant feeding
Training should include content topics listed below. Training and materials provided should be free of commercial influence/ logos. Formula feeding preparation education should not be offered in grouped education or be included in all-inclusive education books. If no prenatal education is offered by facility, coordination of messaging and education should be made with community partners and those partners are identified.
- Importance of exclusive breastfeeding
- Non-pharmacologic pain relief options for labor
- Importance of early skin-to-skin contact and early breastfeeding initiation
- Rooming-in on a 24-hour basis and education on safe sleep and SIDS risk reduction
- Feeding on demand
- Frequent feeding to assure optimal milk production
- Effective position and latch
- Exclusive breastfeeding for the first 6 months, and that breastfeeding continues to be important after 6 months when other foods are given
- Risks associated with formula feeding before breastfeeding is established
- Provide information on accessible community resources
Support documents can include flyers, patient education communication or posters educating on SSC.
Support documents can include images of patient education posters or other communications too large to attach in email.
- Include patient education on hand expression, setup/cleaning of breast pump and safe storage of human milk.
- Consents used for supplementation and or education of impact of formula (if applicable).
- Include status (screenshot) on BantheBags.org to demonstrate removal of formula gift bags in your facility.
- Include education used with parents to teach safe formula prep, cue-based feeding and newborn stomach capacity. Information should not be included in group education class or education book accessed by all patients.
Support documents can include posters or flyers communicating to the public and patients on the practice of rooming-in, visitor’s hours or observed nap time.
- Include information on how visitor’s hours, observed rest periods or golden hour are communicated to patients and family, if applicable.
- Include information on model of care used to transition infant to Postpartum care and process to ensure rooming-in occurs 23 out of 24 hours.
- Include information (consent form if used) on education given and how information is documented when the mother requests her newborn be taken to the nursery.
- Include information used to provide education on safe sleep and SIDS risk reduction.
Support documents can include flyers, posters or any other patient communication to demonstrate education on cue-based feeding. Include the infant feeding tracking log.
- Information should include education on initiation and satiety cues communicated to all moms, regardless of feeding method.
- Information can include education to parents and staff on normal baby behavior patterns (i.e. feeding cues, sleep patterns and crying), if applicable.
- If WIC materials are used, please provide stock # or title of material used (there is no need to provide full WIC forms).
- Include consent for pacifiers (if applicable).
- Include patient education on the AAP recommendation for pacifier use, education on use of alternative feeding devices.
Support documents can include community resources lists or discharge books that include community resources (only include the page that lists resources). All resource lists should include review dates to ensure resources listed are current.
Additional support documents can include flyers announcing outpatient services and call sheet template used during post-discharge breastfeeding follow-up calls.
- Include information on community-based breastfeeding resources listed on application.
- Include information on how hospital-based breastfeeding support is offered (outpatient visits, follow-up phone calls, support groups, hotlines, Baby Café, etc.)
- Include information on when/ how the first pediatric follow up is made.
- Include information/ documentation to support how staff help develop a patient breastfeeding plan.